TRANSNASAL ENDOSCOPIC SURGERY - Dr. P. THULASI DAS
CSF RHINORRHOEA
The brain floats in
cerebrospinal fluid (CSF) which acts as a shock absorber. Sometimes
this fluid comes out through the nose through a defect in the bone
separating the nose and the brain, a condition called CSF
rhinorrhoea.
The patients carry a
risk of meningitis if the defect is not sealed. The neurosurgical
procedure used hitherto to plug this defect involves cutting open
the skull (craniotomy), lifting up the brain, searching for the
defect and plugging it with fascia. This is a major procedure,
associated with morbidity and recurrence rate.
Click below image to enlarge view
Intracranial repair of CSF fistula
Transnasal endoscopic repair of CSF fistula
Using Endoscopic
techniques, the site of leak is located from the nose since the roof
of the nose forms the floor of the brain and the leak can be plugged
with cartilage and fascia. At Sinus and Nose, we have done over 200
endoscopic repairs of CSF fistulae in the last 15 years. Today our
technique is pretty much standardised. For small defects we use
temporalis fascia onlay. For defects larger than 4mm, we use
cartilage inlay and temporalis fascia onlay. We have repaired
defects up to 2cm with septal cartilage. 3 patients required a
second procedure, of which one required a third procedure. None
required intracranial neurosurgical intervention. The overall
success rate is 100%. This procedure can be repeated without much
fuss in case of recurrence.
